City Presentation - Optos

Optos:
Supporting The Continuum of Retinal Care
2nd November 2011
London
1

Forward-Looking Statements
Certain statements made in this presentation are forward-looking statements. These forward-looking
statements are not historical facts but rather are based on the Company's current expectations, estimates and
projections about its industry, its beliefs and assumptions. Words such as 'anticipates,' 'expects,' 'intends,'
'plans,' 'believes,' 'seeks,' 'estimates,' and similar expressions are intended to identify forward-looking
statements. These statements are not guarantees of future performance and are subject to known and
unknown risks, uncertainties and other factors, some of which are beyond the Company's control, are difficult to
predict and could cause actual results to differ materially from those expressed or forecasted in the forwardlooking
statements. The Company cautions shareholders and prospective shareholders not to place undue
reliance on these forward-looking statements, which reflect the view of the Company only as of the date of this
presentation. The forward-looking statements made in this presentation relate only to events as of the date on
which the statements are made. The Company will not undertake any obligation to release publicly any
revisions or updates to these forward-looking statements to reflect events, circumstances or unanticipated
events occurring after the date of this announcement except as required by law or by any appropriate
regulatory authority.
2

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
3

Roy Davis
CEO

Introductions
The Optos Team today…
Roy Davis
CEO
Mike Geraghty
EVP Global Sales
Tom Motta
VP Global Operations
Christine Soden
CFO
Tom Daniells
VP Business Development
Alex Warnock
VP R&D
Quinn Lyzun
VP Sales – USA East
Wouter Donders
VP Sales – Europe
Dave Ianetta
Director Strategic Marketing
Bryan Farrell
Director Strategic Marketing
Anne-Marie Cairns
Director - Clinical
Leslie Amodei
Director Tactical Marketing
5

Introductions
Our Guest Speakers…
Dr Jerry Sherman
OD, FAAO, SUNY School of Optometry Teaching Professor
Editor / Author of retinarevealed.com
Dr Szilard Kiss
Assistant Professor of Ophthalmology
Director of Clinical Research
FELLOWSHIP: Massachusetts Eye & Ear Infirmary, Harvard Medical School
RESIDENCY: Massachusetts Eye & Ear Infirmary, Harvard Medical School
MEDICAL SCHOOL: Columbia University College of Physicians & Surgeons
Dr Paolo Stanga
Consultant Ophthalmologist and Vitreoretinal Surgeon for the Manchester
Royal Eye Hospital and Associate Professor of Ophthalmology for the
University of Manchester
6

Objectives Of The Meeting
‣ To explain why eye care matters
‣ To provide you with an update on our vision and strategy and how we are
progressing on delivering it
‣ To provide you with more details regarding our new technologies, their
potential and progress to date – Daytona, 200Tx, OCT and Optos Advance
‣ To demonstrate the clinical value of Optos technology
‣ To provide an opportunity to see our products and meet the management
team ‘face to face’!
7

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
8

Tom Daniells
VP Global Business Development

Why Eye Care Matters?
Vision Loss – A Growing Problem
Current Rates of Vision Loss
• Somewhere in the world, someone goes blind every five seconds
• A child goes blind every minute
• Worldwide it is estimated that 7 Million people lose their vision every year and
that 180 Million people are blind or visually impaired
• Rates of vision loss will double by 2020 unless prevention efforts are intensified
Leading Causes of Vision Loss
• Top causes of vision loss are cataracts, glaucoma and age related macular
degeneration (AMD)
• AMD is the leading cause of blindness in people over the age of 55
• Diabetic retinopathy is the leading cause of preventable blindness in the world
• In the US, it is estimated that 24,000 people lose their vision each year due to
diabetes, and all could be saved if proper prevention strategies were in use
Economic and Social Impact
Source: AAO
Source: WHO
Source: AMDAI
• The global cost of vision loss is estimated to be nearly $3 trillion dollars yearly
• Current costs include direct health care expenditure, informal caregiver time, lost
productivity and inefficiencies in raising tax revenue to fund health care
• For age related macular degeneration it is reported to contribute a greater
proportion of the economic burden in developed countries

What is The Retina?

A Healthy Retina
Structure & Function = Healthy Vision
MAIN MENU

The Patient’s View
Healthy Vision
Images courtesy of the National Eye Institute, National Institutes of Health

The Patient’s View
Age Related Macular Degeneration (AMD)
Images courtesy of the National Eye Institute, National Institutes of Health

The Patient’s View
Glaucoma
Images courtesy of the National Eye Institute, National Institutes of Health

The Patient’s View
Diabetic Retinopathy
Images courtesy of the National Eye Institute, National Institutes of Health

What The Doctor Sees?
Traditional Fields of View – up to 15%
SLITLAMP
VIEW
DIRECT
OPHTHALMOSCOPE
BIO

What The Doctor Sees?
The Optomap Field of View – 82%
SLITLAMP
VIEW
BIO

Eye Care Professionals
What Do Optometrists and Ophthalmologists Do?
Optometrist (OD)
‣ Primary Care for Eyes
‣ Generally Healthy Patients
‣ Discover Disease
‣ Ongoing disease management
‣ Some pharmaceutical treatments
(glaucoma, dry eye)
Ophthalmologist (MD)
‣ Secondary and Tertiary Care for
Eyes
‣ Generally Disease Patients
‣ Treat disease
‣ Monitor and assess progression
‣ Pharmaceutical and surgical
treatment delivery

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
20

Roy Davis
CEO

Optos – Our Vision & Strategy
A Clear Focus
Our Vision is…
To Be The Retina Company
22

Optos – Our Vision & Strategy
Supporting The Continuum of Patient Retinal Care
23

Optos – Our Vision & Strategy
What Does ‘Optos – The Retina Company’ Look Like
5 Year Vision*
Retinal Disease
Diagnostics
• Optos Ultra
Widefield Imaging
Systems
• Optos OCT
• Optos Ultrasound
Devices
• Optos Perimeters
Retinal Disease
Management
• Optos Image
Management
Software
Solutions
• Optos On Line
Decision Support
and Referral
Management
Solutions
• Diagnostic
Screening Services
Retinal Disease
Treatment
• Optos Office
Based Treatment
Solutions
• Optos OR Based
Treatment Solutions
* - Bold indicates current capabilities
24

Optos – Our Vision & Strategy
Achieving the Vision – ‘Filling the Cube’
Our strategy is to expand our customer segments, leverage our sales
channel and grow geographically
Geography
South
America
M. East
& Asia
Europe
Segment
North
America
Specialists
Ophthalmology
Optometry
Channel
Create Strong
Sales Channel
Leverage
Core
Technology
Broaden
Core
Products
Expand
Product
Portfolio
25

Optos – Our Vision & Strategy
Measuring Success Financially
Building towards a 20:20 vision…
20 20
20% Revenue Growth
Per Annum
20% Operating
Margin
26

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
27

Dave Iannetta
Director Strategic Marketing

Daytona Product Objectives
Globalising Ultra-Widefield Imaging
Daytona is designed to enable Optos to ‘globalise’ our core widefield
retinal imaging technology
‣ 200 degree widefield retinal fundus imaging – Colour and AutoFluorescence (AF)
modalities
‣ Aimed at Optometrists in North America and both Optometrists and General
Ophthalmologists elsewhere
‣ Small footprint, desktop, easy to ship
‣ Improved image quality – equivalent to P200C product or better
‣ Improved user and patient interaction – improved ease of use
‣ ‘Plug ‘n’ play’ – no complex installation, minimal user training (

The Result – A ‘Game Changer’
The Product will be marketed as Daytona
- Revolutionising Eyecare Globally
30

Daytona – A ‘Game Changer’
What Colour Will You Choose?
31

Image Performance
Clinically Superior Capabilities
Daytona Image Quality
Compared to 200Dx
Daytona Colour
200Dx Colour
Daytona af
‣ Brighter in Periphery
‣ Better Detail in Central Pole
‣ Addition of AutoFluorescence (AF)
capability
32

Clinical Perspectives
Initial Feedback
Positive market feedback
“The Daytona device really has the potential to be a game-changing technology for
Optos in the market.”
Dr David Nelson, OD, Past President of The American Optometric Association
“Optos’s ultra-wide angle imaging when combined with traditional techniques, offers
practitioners an opportunity to clinically improve their disease detection, which provides
better care for patients, and is what we all strive for.”
Dr Kristen Brown, OD, FAAO, New England College of Optometry
“Ultra-widefield AF gives doctors the ability to see the lipofuscin buildup. To see the
cellular activity. To see what they can’t see with traditional tools.”
Dr Jerry Sherman, OD, FAAO, SUNY School of Optometry
33

New Family of Ultra-Widefield Products
Daytona – Expanding The Portfolio
P200C
Core Optometry
Market
Retail / Wellness
Clinical Optometry
Wellness / Some
Referral
+Image Quality
Clinical Optometry
(US)
General
Ophthalmology
Globally
++Image Quality
Launch 2012
Clinical Optometry
(US)
General
Ophthalmology
Globally
++Image Quality
AutoFluorescence
General
Ophthalmology /
Vit Ret
Disease
Management and
Treatment
++Image Quality
AutoFluorescence
Fluorescein
Angiography
Increased functionality
34

Product Positioning & Pricing
Daytona - Filling The Gap
Optometry Market
DISEASE
MANAGEMENT
Ophthalmology Market
TREATMENT
PLANNING
DIAGNOSIS
(upgraded P200)
200Tx
P
R
I
C
E
WELLNESS
IMAGING
P200C
Daytona
200Dx
P200
FUNCTIONALITY

Market Potential
Large Global Growth Opportunity
Annual Eye
Exams
Current Markets
Future Markets
US Canada UK Germany Spain Scand France Japan A’tralia India China
109m 10m 15.5m 18.8m 12m 4.1m 11.4m 27.3m 8m 53m 80m
Total Practices 35,500 4,700 3,450 8,000 4,450 4250 11800 6,900 5350 23,500 32,900
OD Practices 22,000 2,900 2,050 NA 3400 3700 NA NA 4000 15,000 25,000
MD Practices 13,500 1,800 1,400 2000 950 550 3800 4400 1350 8500 7900
Addressable
Practices
Total
Customers
30,500 4,500 3,450 2,000 4,350 1750 3800 4,400 5350 8500 7900
3,278 264 129 228 14 57 3 10 2 0 20
OD Customers 3,078 262 125 0 0 45 0 0 1 0 10
MD Customers 200 2 4 228 14 12 3 10 1 0 10
Market Share
17% /
2%
9% 4% 11% 0% 3% 0% 0% 0% 0% 0%
Market Type OD OD OD MD MD OD MD MD OD/MD OD/MD MD
Daytona
Strategy
Manage Manage Growth Manage Growth Growth Aggressive Aggressive Aggressive Aggressive Aggressive
Addressable market defined as practices with potential of at least 100 optomap® exams per month.
Source: Company estimates
36

Market Potential
Large Global Growth Opportunity
Annual Eye
Exams
Current Markets
Future Markets
US Canada UK Germany Spain Scand France Japan A’tralia India China
109m 10m 15.5m 18.8m 12m 4.1m 11.4m 27.3m 8m 53m 80m
Currently we have approximately
11% Total Market Share in the US.
Total Practices 35,500 4,700 3,450 8,000 4,450 4250 11800 6,900 5350 23,500 32,900
OD Practices 22,000 2,900 2,050 NA 3400 3700 NA NA 4000 15,000 25,000
MD Practices 13,500 1,800 1,400 2000 950 550 3800 4400 1350 8500 7900
Addressable
Practices
Total
Customers
30,500 4,500 3,450 2,000 4,350 1750 3800 4,400 5350 8500 7900
If we grew to the same 11% it would
mean an additional 4,000 Customers
3,278 264 129 228 14 57 3 10 2 0 20
OD Customers 3,078 262 125 0 0 45 0 0 1 0 10
MD Customers 200 2 4 228 14 12 3 10 1 0 10
Market Share
17% /
2%
9% 4% 11% 0% 3% 0% 0% 0% 0% 0%
Market Type OD OD OD MD MD OD MD MD OD/MD OD/MD MD
Daytona
Strategy
Manage Manage Growth Manage Growth Growth Aggressive Aggressive Aggressive Aggressive Aggressive
Addressable market defined as practices with potential of at least 100 optomap® exams per month.
Source: Company estimates
37

Market Potential
Realising the Growth Opportunity
Different strategies for different markets
‣ Maintaining a higher price in the US to minimalise the potential
cannibalisation of the current installed base
‣ May adopt a more aggressive pricing strategy in some direct markets where
installed base is less of an issue
‣ Manufacturing costs will support expansion into new distributor markets
historically not available

Commercial Roll Out Plan
A Phased Approach
Regulatory approvals drive our roll out plans with current served
markets our initial priority
‣ USA
‣ Canada
‣ Germany
‣ UK
‣ Scandinavia
‣ Benelux
‣ Spain
‣ Switzerland
Phase 1 Phase 2 Phase 3
‣ Australia
‣ India
‣ South Africa
‣ Other EU Countries
‣ Turkey
‣ Middle East
‣ Japan
‣ China
‣ Korea
‣ Brazil
‣ Rest of World
0-9 months 9-18 months 18 months+
Key: Marketing strategy
Bold – Protect installed base
Italics – Growth market
39

Summary
Daytona – The Next Generation Optos Product
‣ Daytona – an improved ultra widefield product offering
- Improved product performance – colour and AF imaging modalities
- Smaller
- Improved ease of use
- Cheaper to install and maintain; manufacturing cost target achievable
- Leading edge design
- Colour customisable
‣ Positive initial clinician reaction – clinical trials planned
‣ Priced to protect core markets and generate incremental growth
‣ Extensive marketing programme to support planned launch
‣ On track for planned Q1 calendar 2012 launch
‣ Phased roll out plan driven by regulatory timing
Daytona – globalising ultra-widefield imaging
40

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
41

Jerome Sherman, OD, FAAO
SUNY Distinguished Teaching Professor
www.retinarevealed.com

Daytona-the beginning and
epicenter of every Retinal exam
OCT
B I O
78D or
90D
3-mirror
lens exam
Refer:
Internist,
etc
DAYTONA
B-scan
ultrasound
ERG
Visual Fields
Microperimetry
Multifocal
ERG

Optos Ultra Wide-field Auto Fluorescence
See what you can’t see with any other technology

What novel information does it give us?

Case 5 : Topcon 3D OCT Fundus Image OD
Case 1‐ A normal appearing retina in a 25 year old complaining about a
new visual problem that has slowed his reading. VA is 20/20 or 6/6 in
each eye.

KEY:
Color Optomap
Green Separation
Auto Fluorescence
Right Eye (OD)
Only the AF image reveals an abnormality in the right eye.

CASE 1: A normal appearing retina in a 25 year old complaining about a new
visual problem that has slowed his reading. VA is 20/20 or 6/6 in each eye.

With AF a bull’s eye maculopathy present with AF but not with standard
imaging. The left eye reveals a peri‐foveal ring of hypo AF as well.

Normal
PIL Present
ELM Present
Patient
PIL Present
ELM Present
PIL Missing
A horizontal section through the fovea of the left eye reveals similar findings as displayed previously in the right eye.
A small, but intact, PIL is present under the fovea and a perifoveal absence of the PIL is documented. With loss of the PIL,
the intact external limiting membrane (ELM) appears to drape over the missing tissue.

KEY:
Color Optomap
Green Separation
Auto Fluorescence
Left Eye (OS)
As in the right eye, only the AF image reveals an abnormality in the left eye

Invisible to Ophthalmoscopy and Fundus Photography
Optomap ResMax Auto-Fluorescence Images
Bull’s Eye Maculopathy
OD
OS

OD vs. OS COMPARISON
Microperimetry Sensitivity Map
OD
OS

Jerome Sherman, OD
www.retinarevealed.com
www.retinarevealed.com

Case 2: A 13 yo Hispanic
female with no visual
complaints and 20/20 VA
both eyes.

CASE 2:
Right Eye

CASE 2:
Left Eye

Bull’s Eye: Invisible to Ophthalmoscopy & Fundus Photography
CASE 2 Diagnosis: Early Retinitis Pigmentosa

Case 3: A 37 yo female with
Lupus and poor vision
RE=20/40 LE =4/400
Cannot dilate because of very
narrow angles
Standard
fundus
photography
SD OCT

SD OCT
Standard
fundus
photography

Case 3: A 37 yo female with
Lupus and poor vision
RE=20/40 LE =4/400
Cannot dilate because of very
narrow angles
Standard
fundus
photography
SD OCT

SD OCT

CASE 3:
AF Optomap

CASE 3:
Right Eye

CASE 3:
Left Eye

CASE 3:
Left Eye

Invisible to Ophthalmoscopy and Fundus Photography
(select findings)
CASE 3 Diagnosis: CSCR/Sick RPE due to steroids

200°
Potential Limitation of Existing FAF
Evaluations
Focused on the posterior pole
Even wider angle fundus camera lens or sweeping covers only a modest territory
50
°
With Optos AF we can now see more
useful information that has never
been seen before !

Q&A

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
70

Bryan Farrell
Director Strategic Marketing

Segmental Growth – Ophthalmology
200Tx – Pushing The Boundaries of UWF Imaging
72

Segmental Growth – Ophthalmology
The Global Retina Market
73

Segmental Growth – Ophthalmology
UWF & OCT – A Unique Diagnostic Combination
Combining Optos’ widefield technology with OCT in an integrated
device will provide a unique product offering
“The combination of a widefield Optos retinal image (Optomap © ) and an OCT image is the
'dream team' from a retinal diagnosis and disease management
perspective”
Dr Simon Barnard PhD FCOptom FAAO DipCL DipClinOptom
“Although I don't see OCT replacing FA 1 , I believe it will soon become a standard imaging
procedure for AMD 2 patients. Currently, I use OCT to supplement FA Interpretation. The
integration of simultaneous OCT and widefield scanning laser ophthalmoscopy is also
under investigation. The potential to both quantify and locate retinal pathology using a
single instrument promises great benefits.”
Peter Kaiser, MD
Associate staff member at Cole Eye Institute
Cleveland Clinic
Notes: 1. FA – Fluorescien Angiography; 2. AMD – Age Related Macular Degeneration
74

Segmental Growth – Ophthalmology
What is OCT?
75

Segmental Growth – Ophthalmology
Competitive Position
76

Segmental Growth – Ophthalmology
OCT Market
‣ The Spectral OCT market is both growing and diversifying, presenting a
unique opportunity for new entrants to quickly gain market share.
77

Segmental Growth – Ophthalmology
OptosAdvance
78

Segmental Growth – Ophthalmology
Innovative Cloud-Based Design
79

Segmental Growth – Ophthalmology
Optos Advance Market Potential
‣ OptosAdvance Single Device systems, all have the ability to be upgraded
through remote software upgrades to perform full PACS functionality.
80

Segmental Growth – Ophthalmology
OptosAdvance – Retina Specialist Exam
81

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
82

How Ultra Wide Field
Imaging changes the way
I manage patients
Szilárd Kiss, MD
Director of Clinical Research
Assistant Professor of Ophthalmology
Weill Cornell Medical College
Weill Cornell Eye Associates

Recent Advances in Clinical Research
•Optos are Committed to investing in Clinical Research in order to
demonstrate our retinal health technology’s excellence in support
diagnosis, management and ultimately the Clinician’s treatment of eye
disease.
•Optos Clinical Research Program extends to over 10 countries, with
more than 50 Clinical Institutions & Hospitals involved to demonstrate
the importance of imaging the whole retina, demonstrating that many
diseases have huge peripheral involvement that is proving to be
clinically of significance.
•In the last year over 10 Clinical Research Papers were published in
scientific journals with more than 50 clinical trials presented
Internationally by some of the world’s most important Ophthalmology
Key Opinion Leaders.

The results were presented at the 2011 ARVO annual meeting, final manuscript submitted for publication.
With permission of Beetham Eye Institute, Joslin Diabetes Centre.

•Optos most comprehensive diabetic retinopathy validation study to
date was performed by the Beetham Eye Institute/ Joslin Diabetes
Center, a leading academic center for evaluation, management, and
clinical investigation into diabetic eye disease.
• 206 eyes of 103 patients with type 1 or 2 diabetes and a broad
distribution of diabetic retinopathy (DR) and diabetic macular edema
(DME) severity were evaluated.
•Retinopathy severity level gradings from these images were
compared to gradings from gold standard 35 mm seven standard
field stereoscopic images according to Early Treatment Diabetic
Retinopathy Study protocol (ETDRS photos).
With permission of Beetham Eye Institute, Joslin Diabetes Centre.

•The results demonstrated that undilated 200 degree Optos images had
excellent agreement with both dilated ETDRS photos and dilated fundus
examination in determining severity level of DR and DME.
•In grading DR severity, Optos images demonstrated high agreement
and substantial to almost-perfect correlation with both lesion level and
clinical level grading of ETDRS photos.
•Acquisition of Optos images though an undilated pupil was twice as
fast as obtaining dilated ETDRS photos after dilation, leading the
Investigators to comment that
“If these results are confirmed in a broader diabetic population,
Optos ® imaging may be applicable to both research and clinical
settings with the additional benefit of easier acquisition through an
undilated pupil.”
•Planning of a follow-up multicentre study is underway.
With permission of Beetham Eye Institute, Joslin Diabetes Centre.

With permission of John Hopkins Medicine, Wilmer Eye Institute.

Interim Results
• 63 patients with non-infectious
posterior, intermediate, or panuveitis
enrolled
• 23 patients with retinal vasculitis
•71 visits total
•15 patients with 2 or more visits
With permission of John Hopkins Medicine, Wilmer Eye Institute.

Preliminary Results
Table 2:
Disease
Activity
(n=71)
P
Change in
Management
(n=71)
P
Exam 38.02% 5.63%
+FA 45.07% 0.49* 10% 0.47*
+Widefield
images
+ Widefield
FA
50.70% 0.20* 23% 0.01*
51%

Conclusions
• Employment of Optos P200 Ultra-widefield
imaging with FA Leads to statistically significant
difference in diagnosing active vasculitis when
compared to clinical exam alone
• Relevance of “additional” diagnostic information
• Change in therapy
• Improve disease outcome ?
With permission of John Hopkins Medicine, Wilmer Eye Institute.

Szilárd Kiss, MD

Traditional Photography:
30 Degrees
Szilárd Kiss, MD

Szilárd Kiss, MD
ETDRS: 7 Standard Fields

Optos Ultra-Wide-Field
Szilárd Kiss, MD
Peripheral Neovascularization

Szilárd Kiss, MD

Szilárd Kiss, MD
ETDRS 7 Standard Fields

Szilárd Kiss, MD
Peripheral Non-Perfusion & NV

Outline Ischemia, Non-
Perfusion, Neovascularization
Szilárd Kiss, MD

Szilárd Kiss, MD
ETDRS 7 Standard Fields

Szilárd Kiss, MD
Peripheral Non-Perfusion & NV

Results
Three distinct patterns of
retinopathy:
Pathology primarily outside of
ETDRS 7SF;
Involvement of both posterior and
peripheral retina;
Pathology confined to posterior pole;
Szilárd Kiss, MD
‘Hotbed’ of retinopathy just outside
the arcades

Results
UWFA imaging, on average,
demonstrated 3.2 times more total
retinal surface area than 7SF.
• When compared with 7SF, UWFA
showed 3.9 times more nonperfusion/ischemia
(p

Clinical Relevance
Improved visualization can alter the
classification of DR
Improved visualization may influence followup
and treatment of these patients.
Implications - relationship between
peripheral ischemia and DME; targeted
peripheral laser; effect of anti-VEGF therapy
on peripheral ischemia.
Szilárd Kiss, MD

Szilárd Kiss, MD

Peripheral Non-
Perfusion and
Vascular Remodeling
Szilárd Kiss, MD

Peripheral Non-
Perfusion and
Vascular
Remodeling
Szilárd Kiss, MD

Peripheral Non-
Perfusion and Sea-
Fan
Neovascularization
Szilárd Kiss, MD

Peripheral and
Macular Vascular
Abnormalities
Highlighted
Szilárd Kiss, MD

Szilárd Kiss, MD

Szilárd Kiss, MD
Idiopathic Retinal Vasculitis

Retinal Vasculitis
Confined to Left Eye
Szilárd Kiss, MD

10 Days Following Steroid Treatment
Szilárd Kiss, MD
Peripheral Ischemia

Szilárd Kiss, MD
Following anti-VEGF and Laser

Szilárd Kiss, MD
Retina Artery Occlusion

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
116

How Ultra Wide Field Imaging
impacts retinal treatment
paradigm?
Prof. P. E. Stanga
Professor of Ophthalmology & Retinal Regeneration
Consultant Ophthalmologist & Vitreoretinal Surgeon
p.stanga@retinaspecialist.co.uk
The Royal Eye Hospital & University of Manchester

P Stanga

Why limit ourselves to seeing only
the posterior pole (20% of the
retina) with high resolution colour,
FFA and AF imaging?
P Stanga

Peripheral TRD in PDR

PRP in PDR

Treated Retinoblastoma

CHRPE

Giant Retinal Tear (GRT)

Bullous RD with Tear

Buckling for PVR detachments of moderate degree
Less than 24hrs. (non-drain cryo/buckle)
Manchester, UK
P Stanga

RD after Cryo/Buckle

Juxtafoveal Telangiectasia
P Stanga

Uveitis

Chicken Pox Virus

While there is no substitute for binocular indirect ophthalmoscopy of
the retina, Optos ® wide-angle imaging enable visualisation and
documentation of peripheral pathology that may occasionally go
unnoticed, especially in the treatment of children
P Stanga

Normal Child Fundus

Leucocoria: Retinoblastoma

Multilocular Retinoblastoma

Leucocoria:
Retinoblastoma

Coat’s

Coat’s Response to Laser & anti-VEGF

Pilot Study of Optos ® -guided PASCAL
TargETEd Retinal vs. Variable Fluence
PANretinal 20ms Laser in Proliferative
Diabetic Retinopathy:
The Peter Pan Study
First ever published randomised clinical trial on TRP
Acta Ophthalmologica (in press)

Optos ® Wide-angle Fundus Fluorescein Angiogram
©P Stanga

Diabetic Post Laser

Proliferative Diabetic Retinopathy with NVD
P Stanga

Diabetic Retinopathy

Purpose
• To investigate the efficacy and safety profile of 2 new Pascal
regimens in treatment-naive PDR :
1. Optos®-guided targeted retinal photocoagulation
(TRP)
2. Reduced fluence/minimally-traumatic PRP
(MT-PRP)
compared to standard-intensity PRP (SI-PRP)

Study Methods
• Design: Single-center, prospective, RCT (July 2010-Jan 2011)
• Participants: 30 eyes of 24 patients
• Methods: 3-arm RCT
Randomization to 10:10:10
(TRP:MT-PRP:SI-PRP)
• Intervention: Multi-spot 20ms Pascal 4*4/5*5 arrays.
2,500 burns applied in a single-session
• Tests: ETDRS visual acuity (VA), central subfield retinal thickness
(CRT, µm) by 3D-OCT, and 24-2 SITA-Std and multispectral imaging
were recorded at baseline and 4- , and 12-weeks post-laser.
• Grading: Neovascular activity was assessed by 2 masked retina specialists
using Optos® color photographs and wide-field angiography

TRP
Green-free and
Optos ® -
autofluorescence
MT-PRP
Color and
Optos ® -
autofluorescence
SI-PRP
Color and
Optos ® -
autofluorescence
©P Stanga

Conclusions
This pilot study reports that
Optos®-guided
20ms-Pascal TRP and Pascal MT-PRP
using 2,500 burns
may be as effective as Pascal SI-PRP
with no ocular adverse events
observed in the short-term

The Manchester Practice:
Most retinopathies undergo wide-angle imaging

Why limit ourselves to seeing only
the posterior pole (20% of the
retina) with high resolution colour,
FFA and AF imaging?
P Stanga

The Manchester Practice:
Most retinopathies undergo wide-angle imaging
We carry out wide-angle Optos ® AF imaging of
photocoagulated eyes as well as prior to repeating laser
procedures

AF-guided Laser
©P Stanga

AF-guided Laser
©P Stanga

The Manchester Practice:
Most retinopathies undergo wide-angle imaging
We carry out wide-angle Optos ® AF imaging of
photocoagulated eyes as well as prior to repeating laser
procedures

The Manchester Practice:
Most retinopathies undergo wide-angle imaging
We carry out wide-angle Optos ® AF imaging of
photocoagulated eyes as well as prior to repeating laser
procedures
It may no longer be acceptable to run a Retina Service
without Wide-angle Imaging!

Q&A

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
155

Quinn Lyzun
VP Sales – USA

Leveraging The Sales Channel
Product Expansion – The Past
2 years ago…1 technology….3 products
‣ P200 – Workhorse of Optos
- Demonstrated the concept of Ultra Wide Field imaging
- Created the “Roadmap to the Retinal Exam”
- Trained doctors to reverse the order of the exam…do the health portion of
exam first!
- Paved the way for newer, clinically significant products (P200C, P200MA)
‣ P200C product focused on clinical optometrists
- Wider field view than 200 and better central pole resolution
‣ P200MA with FA focused on Vit Ret market
- Revolutionizes FA experience for diabetic patients and efficiency of
fundus photographers

Leveraging The Sales Channel
Product Expansion – Today
Today….multiple products
‣ A strong installed based of over 4,200 devices
‣ 200Tx evolves (improved P200MA)
- includes AF and the XYZ patient interface provides the imaging capability
necessary in this market
- Base model without FA (blue laser) provides the technology at an
affordable price for general ophthalmology
‣ Daytona!
- Opens markets that required a smaller more affordable unit
- Strong central pole resolution
- Functionality differentiates from the rest of install base… smaller footprint,
improved design and increased functionality equals higher price
- Eye-steering of P200C series is a major reason for clinically focused
practitioners to stay with what they have

Leveraging The Sales Channel
Meeting more needs in a practice
Today….multiple products…meeting more of the practice needs
‣ OCT
- UWF imaging provided the “where” in the retina and now Optos has the
solution for the “what!”
‣ Treatment Lasers
- Yag, Mitra, Hyalus, 532…
‣ Office based products for diagnostic testing…
- Perimeters, smart charts
‣ OptosAdvance
- PACS allows doctors to combine and view multi-modality imaging
devices in a centralized manner

Leveraging The Sales Channel
Product by Segment – the OD vs MD market
The Optometry market…
‣ Products: P200/DX/C, Perimeters, Smart Chart… Daytona!
‣ US, UK, Scandinavia and Australia…
‣ Key Drivers:
- Retail optometrists: raises clinical standard; patient experience; ease of
use; practice differentiation; revenue stream for practice (patient pay)
- Clinical optometrists: all of the above plus disease co-management and
referral to MDs

Leveraging The Sales Channel
Product by segment – the OD vs the MD
The Ophthalmology market…
‣ Ophthalmology represents a major growth segment for Optos
‣ New market in USA due to product differentiation from OD market
‣ Main market in Europe, Japan and ROW
‣ TX series…
‣ TX base with its XYZ stage allows easier patient interface for elderly and
diseased patients
‣ AF allows for early detection of dead and dying cells without FA
‣ Branded for MD’s
‣ Wider field and stronger central pole resolution picks up more disease
than MD’s (general) could formerly see and increased billing equals
increased revenue stream for practice
‣ Better price point allows more MD’s to access
‣ More Vit Ret using the FA model makes this technology more clinically
relevant to MD’s in general

Leveraging The Sales Channel
Product by segment – the OD vs the MD
The Ophthalmology market…
‣ OCT
- Micro perimetry and eye-tracking give it an edge over most competitors
and it is relevant in both the OD and MD markets
‣ Ancillary products
- Treatment lasers for MDs
- Front office diagnostic equipment smartcharts and perimeters useful in
both OD and MD markets
- OptosAdvance brings PACS to both OD and MD markets

Leveraging The Sales Channel
Key success factors
You are as good as your sales people…
‣ Strong sales management – industry based and proven successful
‣ Optos “story” has the best people in the industry wanting to work for
us
‣ Training: makes our people credible and useful
‣ Incentives: put the pot of gold where you want the sales people to go
and they drive the company growth
‣ Products:
- New products allow us to sell more to current customers
- New products give us a reason to talk to new customers

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
164

Wouter Donders
VP Sales – Europe

Growing Geographically

Growing Geographically
International Growth – A Global Opportunity
9%
79%
11%
1%
22%
92%
6%
2%
68%
10%
167

Growing Geographically
Optos Direct & Indirect Markets – 2012
Optos UWF, Opto Global & Opko Markets – 2012

Growing Geographically
Key Growth Drivers, Opportunities – Direct Markets
Expansion Optos Direct channel
1. Extra Sales Staff Existing Markets
2. Opening New Direct markets Australia, Singapore, Benelux, Austria
3. Via Commission agents in France, Denmark, Finland, Poland
Go for Market Penetration
Do more ‘On Patient Demonstrations’
Introducing new Simplified Contracts
Utilise new installed base
169

Growing Geographically
Key Growth Drivers, Opportunities – Indirect Markets
Focus on Driving Sales Key Distributor Markets:
Turkey, Italy, S Africa, India, China, Japan, S. Korea, Saudi Arabia
Optimize the Distributor Channel
Drive Distributor Sales Optos, Opko and OG Products
Main Product Focus UWF Daytona
Overcome Market Entry Barriers
170

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Future R&D Plans
9. Summary
Appendices
171

Alex Warnock
VP Global R&D

Future R&D Plans
R&D Capability
‣ Diverse team in 3 locations - Dunfermline, Canterbury and Miami
‣ Total of 45 heads of which ~ 25% PhD qualified
‣ Structured around Research, New Product Development, and Project Management
‣ Range of expertise covering SLO imaging, OCT, Lasers Systems and
Software.
Specific capability includes:
• Electronics: Analogue Design, Sensor/Detector Systems, High Speed Digital, Firmware Development
• Opto/Mechanics : Optical Design, Lens Systems, Laser and Gaussian Optics, Optical Modelling and
Tolerance Analysis, Thermal Modelling, Industrial and Mechanical System Design
• Software: Application, Algorithmic and Embedded, UI design, DICOM, Image Management,
Networking, Multiple OS Support
‣ Strong Intellectual Property portfolio with 18 granted patents and 20 pending patents
• Extension of SLO core patent claims granted as follow on patent
• Expiry in 2027
‣ 2011 spend approx 6.5% of sales revenue (based on trading update) vs. 4.5% in FY10
173

Future R&D Plans
Product Roadmap
TODAY MID TERM FUTURE
Optometry General Ophthalmology Vit Ret
200Tx
(R/G/FA/AF)
P200MA
(R/G/FA)
Current
Spectral OCT/
SLO
P200C
(R/G)
200Dx
(R/G)
P200
(R/G)
Daytona
(R/G/AF)
Next Gen
200Tx
Next Gen Full
Feature Spectral
OCT/ SLO
Low Cost
Desktop
Spectral OCT
Full Feature
Desktop Spectral
OCT/SLO
Next Gen
Daytona
Desktop Next
Gen 200Tx
Wide Field SLO Products
Future Gen
Low Cost Platform - Configurable by Module
OCT Products
Integrated Products

Future R&D Plans
Product Pipeline Summary
An exciting pipeline…
‣ Additional imaging modalities to drive enhanced disease diagnosis
‣ Delivery of standalone and integrated wide field OCT products
‣ Image Management and Decision Support/Disease Management Software
‣ Improved registration and measurement capability
‣ Integration of ‘See and Treat’ applications through effective convergence of
parallel technologies e.g. treatment lasers
175

Q&A

Agenda
1. Welcome, Introductions and Objectives of the Meeting
2. Why Eye Care Matters?
3. Optos – Our Vision and Strategy
4. Segmental Growth – Optometry
A. Key Growth Driver – Daytona
B. See More with Optos Technology – Dr Jerry Sherman
5. Segmental Growth – Ophthalmology
A. Key Growth Drivers – 200Tx, OCT and Optos Advance
B. How Ultra Wide Field Imaging changes the way I manage patients
– Dr Szilard Kiss
C. How Ultra Wide Field Imaging impacts retinal treatment paradigm
– Dr Paolo Stanga
6. Leveraging the Sales Channel
7. Growing Geographically
8. Summary
Appendices
177

Summary
Optos – Supporting The Continuum of Retinal Care
‣ Optos has a clear vision – To Be The Retina Company
‣ Macro environment supports the importance of eyecare globally
‣ We are making good progress in both optometry and ophthalmology – with
strong clinical evidence of our value to clinicians
‣ Daytona represents a key driver in globalising ultra widefield retinal imaging
‣ The 200Tx, OCT and Optos Advance are all key drivers in supporting our
penetration in ophthalmology
‣ Beyond these drivers we have exciting new products in the R&D pipeline
Optos – exciting growth opportunities globally
178

Q&A

Appendices
‣ Clinical Papers
‣ Posters
‣ Product Marketing Literature

Appendices
‣ Clinical Papers
‣ Posters
‣ Product Marketing Literature

Appendices
‣ Clinical Papers
‣ Posters
‣ Product Marketing Literature